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10616 ROBIN HOOD
DR
ADDRESS: 4 �D
TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION: ❑ Conditional Waiver Study Required ❑ Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (
PLANNING DATA CHECKLIST DA
SCALED PLOT PLAN DA
SEWER LID FEE $:
LID #:
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DA
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT
FOR:
WATER METER TAP CARD DATED:
LATEMP\DS7's\Forms4Street File Checklist.doc
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CITY
121 5TH AVENUE NORTH - EDMONDS,WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20060469
RIGHT OF WAY PERMIT (6-EUC Blanket)
Permit Number: ENG20060469 Expiration Date: 12/17/2006
Job Address: 10616 ROBIN HOOD DR, EDMONDS Location:
APPLICANTO.
PILCHUCK CONTRACTORS INC
13330 STONE AVE N
SEATTLE, WA 98133
LICENSE #: EXP:
0 DESCRIPTION
Install gas service. Tracking # 106186183.
DISRUPTION INFORMATION
ASSESSED VALUE: $0.00 PROPERTY AREA: 0
SIDEWALK: (OXO ) DURATION IN MONTHS: 0 FEE: $0.00 STREET DISRUPTION TRENCH CUT: ( 0 X 0 )
PARKING: ( OXO ) DURATION IN MONTHS: 0 FEE: $0.00 YEAR OF OVERLAY: 0 FEE: $0.00
ALLEY: ( OXO ) DURATION IN MONTHS: 0 FEE: $0.00
INDEMNITY.- The Applicant has signed an application which states he/she holds the City of Edmonds harmless from injuries,
damages or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds or
any of its departments or employees, including but not limited to the defense of any legal proceedings including defense costs and
attorney fees by reason ofgranting this permit.
TIIECONTRACTOR IS RESPONSIBLEFOR WORKMANSHIP AND MATERIALS FORA PERIOD OFONEYEAR FOLLOWING "I7IEFINAL
INSPECTION AND ACCEPTANCEOFTHEWORK.
Traffic Control and public safety shall be in accordance with City regulations as required by the City Engineer. Every flagger must
be trained as required by (WAC) 296-155-305 and must have certification verifying completion of the required training in their
possesion.
Restoration is to be in accordance with City codes. All street -cut trench work shall be patched with asphalt or City approved
material prior to the end of the workday -NO EXCEPTIONS.
Three sets of construction drawings of proposed work are required with the perniit application.
CALL DIAL -A -DIG (1-800424-5555) BEFOREANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT. 1326
24 HOUR NOTICEREQUIRED FORALL INSPECTION REQUESTS
APPLICATION APPROVAL
MISAPPLICATION IS NOT PERMIT UNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPT IS ACKNOWLEDGED IN
SPACE PROVIDED.
Printed: Tuesday, October 17, 2006
RELEASED BY
DATE
FILE COPY INSPECTOR COPY APPLICANT COPY
0
0
STATUS: ISSUED
ENG20060469
• Restore ROW to City standards
• Restore Landscape to like or better conditions.
• Call for locates of underground utilities prior to any a)cavation.
• Public utilities maintain 5' separation from City Utilities.
• Verify clear bore crossings
• Utility patch restoration to be in accordance with Edmonds Standard detail E2.3
• Maintain erosion & sedimentation control. Keep street clean.
• Construction hours are Monday -Friday 7am-6pm and Saturdays l0anr6pm. No work on Sundays or Federal Holidays.
• Traffic Control per approved plan and MUTCD. Refer to City of Edmonds traffic control requirements.
• Trenching within the City Right -of -Way is limited to 1001f.
INSPECTIONS
• E-Engineering Final
PARTIAL INSPECTION DATE: INITIAL: NOTES:
PARTIAL INSPECTION DATE: INITIAL: NOTES:
FINAL INSPECTION APPROVED DATE: INITIAL:
o-f EDAI
A° CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS,WA 98020
�ryc 1 gq0 PHONE: (425) 771-0220 - FAX: (425) 771-0221
PERMIT FEES/ RECEIPT
DATE: Tuesday, October 17, 2006
PERMIT #: ENG20060469
PROJECT ADDRESS: 10616 ROBIN HOOD DR, EDMONDS
PROP OWNER: BAKKEN BRADLEYB & KAREN L
10616 ROBIN HOOD DR
EDMONDS, WA 98020-6161
* FEE S UMMARY:
Description _ - ^- - ':Fee Amount Paid W._ _ Balance
_
X-Permit Surcharge Fee
$15.00
$0.00
$15.00
E-Right of Way Permit Fee
$160.00
$0.00
$160.00
E-Engineering Inspection Fee
$50.00
$0.00
$50.00
Total Due:
$225.00
$0.00
$225.00
*FEES ARE ESTIMATED BASED ON INFORMATION PROVIDED AT SUBMITTAL -SUBJECT TO CHANGE
"M,NT'HUNSACUONS:TO BE BILLED QUARTERLY